Helle K. Schoeyen

Bipolar disorder patients have similar levels of education but lower socio-economic status than the general population

BACKGROUND There is conflicting evidence regarding the educational level and its importance for social and occupational functioning in bipolar disorder (BD). The aim of this study was to investigate how educational achievement relates to function in BD compared with the general population, and which clinical factors are associated with level of education. METHODS Hospitalized patients with DSM-IV BD (N=257; 69.3% BD I; 25.7% BD II; 5.1 BD NOS; 51.4% females) were consecutively recruited from mental health clinics throughout Norway and compared with a geographically matched reference sample from the general population (N=56,540) on levels of education, marital status, income, and disability benefits. Further analyses of association were carried out using logistic regression analyses. RESULTS A significantly higher proportion of subjects in the BD group than in the reference group was single, had low income, or was disabled. No between-group difference was found in educational level. In the reference group education was inversely correlated with the risk of being disabled, but no such relationship was found in the BD group. Rapid cycling and recurring depressive episodes were the only clinical characteristics associated with low educational level. LIMITATIONS Acutely admitted patients might not be representative for milder forms of disease. CONCLUSIONS Despite similar levels of education, BD patients had lower social and occupational function than the general population, and no association was found between education and disability for BD patients.

The Effect of Electroconvulsive Therapy on Neurocognitive Function in Treatment-Resistant Bipolar Disorder Depression

OBJECTIVE To compare the effects of right unilateral (RUL) electroconvulsive therapy (ECT) and algorithm-based pharmacologic treatment (APT) on neurocognitive function in treatment-resistant bipolar disorder depression. METHOD Inpatients with DSM-IV-TR-diagnosed, treatment-resistant bipolar depression, who were acutely admitted to 1 of the 7 clinical study centers in Norway, were recruited from May 2008 to April 2011 into a prospective, randomized controlled, 6-week acute treatment trial. General neurocognitive function was assessed with the MATRICS Consensus Cognitive Battery (MCCB), and retrograde memory for autobiographical events was assessed with the Autobiographical Memory Interview-Short Form (AMI-SF) before and shortly after (mean = 23.5 days) a trial with either RUL brief-pulse ECT (mean dose = 233.3 mC) or APT. RESULTS Seventy-three patients entered, and 39 (nECT = 19, nAPT = 20) completed. Both groups showed improvements in all MCCB domain scores, with no significant differences between the study groups (no interaction effect: F₁,₃₇ = 1.52, P = NS). Improvements in neurocognitive performance were significantly correlated with reductions in depression ratings posttreatment. The AMI-SF score was significantly lower (based on consistent answers from pre- to posttreatment) in the ECT group (72.9%) than in the APT group (80.8%, P = .025), indicating reduced consistency in autobiographical memory after ECT. CONCLUSIONS General neurocognitive function was unaffected by RUL brief-pulse ECT treatment and positively related to improved mood in bipolar depression. Autobiographical memory consistency was reduced in patients treated with ECT. The results suggest that ECT can be used in treatment-resistant bipolar depression without compromising general neurocognitive function. The clinical relevance of reduced autobiographical memory consistency in the ECT group requires further investigation. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00664976.

Neurocognitive profiles in treatment-resistant bipolar I and bipolar II disorder depression

BackgroundThe literature on the neuropsychological profiles in Bipolar disorder (BD) depression is sparse. The aims of the study were to assess the neurocognitive profiles in treatment-resistant, acutely admitted BD depression inpatients, to compare the neurocognitive functioning in patients with BD I and II, and to identify the demographic and clinical illness characteristics associated with cognitive functioning.MethodsAcutely admitted BD I (n = 19) and BD II (n = 32) inpatients who fulfilled the DSM-IV-TR criteria for a major depressive episode were tested with the MATRICS Consensus Cognitive Battery (MCCB), the Wechsler Abbreviated Scale of Intelligence, the National Adult Reading Test, and a battery of clinical measures.ResultsNeurocognitive impairments were evident in the BD I and BD II depression inpatients within all MCCB domains. The numerical scores on all MCCB-measures were lower in the BD I group than in the BD II group, with a significant difference on one of the measures, category fluency. 68.4% of the BD I patients had clinically significant impairment (>1.5 SD below normal mean) in two or more domains compared to 37.5% of the BD II patients (p = 0.045). A significant reduction in IQ from the premorbid to the current level was seen in BD I but not BD II patients. Higher age was associated with greater neurocognitive deficits compared to age-adjusted published norms.ConclusionsA high proportion of patients with therapy-resistant BD I or II depression exhibited global neurocognitive impairments with clinically significant severity. The cognitive impairments were more common in BD I compared to BD II patients, particularly processing speed. These findings suggest that clinicians should be aware of the severe neurocognitive dysfunction in treatment-resistant bipolar depression, particularly in BD I.Trial registrationTrial registration number: NCT00664976

Blue-blocking glasses as additive treatment for mania: a randomized placebo-controlled trial

The discovery of the blue lightsensitive retinal photoreceptor responsible for signaling daytime to the brain suggested that light to the circadian system could be inhibited by using blue‐blocking orange tinted glasses. Blue‐blocking (BB) glasses are a potential treatment option for bipolar mania. We examined the effectiveness of BB glasses in hospitalized patients with bipolar disorder in a manic state.

Occupational outcome in bipolar disorder is not predicted by premorbid functioning and intelligence

Bipolar disorder (BD), over the long term, can manifest a variety of outcomes depending on a number of different conditions. There is a need for further knowledge regarding preventive factors as well as predictors of the disabling course of the disorder. Studies regarding the impact on functional outcome of premorbid and current general intellectual function [intelligence quotient (IQ)] and premorbid functioning in BD patients are sparse. The present study addressed the role of premorbid functioning [assessed with the Premorbid Adjustment Scale (PAS)], intelligence, course of illness, and sociodemographics on occupational outcome in BD.

Despite clinical differences, bipolar disorder patients from acute wards and outpatient clinics have similar educational and disability levels compared to the general population

BACKGROUND The aims of this study were to compare clinical characteristics and educational and occupational functioning in two Bipolar Disorder (BD) samples recruited respectively from acutely admitted inpatients and public outpatient clinics and to investigate if the two BD samples differed in the same way in education and work ability from the general population. METHODS DSM-IV BD patients were consecutively recruited from acute wards throughout Norway (N=252; 69.8% BD I; 25.0% BD II; 5.2% BD NOS) and from outpatient clinics in the Oslo region (N=230; 60.4% BD I; 33.5% BD II; 6.1% BD NOS) and demographic and clinical characteristics were compared. A reference sample from the general population (N=100 869) was used to compare levels of education, marital status and disability benefits. RESULTS The acute ward sample was older, and had more men, more BD I disorder, more hospitalisations and suicide attempts, longer illness duration, an earlier age of onset and first treatment and used a higher number of antipsychotics, anticonvulsants and lithium than the outpatient sample. Both samples were educated to the same level as their respective reference populations, but received disability benefit and were single to a higher but similar degree. CONCLUSIONS Clinical differences between the BD samples had no consequence for educational achievement and receipt of disability benefit compared to the general population indicating that other factors than severity of illness play a role for education and work abilities in BD patients.

Psychotic Depression and Suicidal Behavior

Objective: This study investigated how severely depressed individuals experienced the relationship between psychotic symptoms and suicidal ideation and behavior. Method: Semi-structured qualitative interviews were conducted with a purposive sample of nine inpatients from a psychiatric university hospital between September 2012 and May 2013 fulfilling diagnostic criteria for a psychotic depressive episode as part of a unipolar or bipolar disorder. Analysis was conducted using systematic text condensation. Results: Participants experienced (1) being directed to perform impulsive potentially fatal actions, (2) feeling hounded to death, (3) becoming trapped in an inescapable darkness, and (4) being left bereft of mental control. They described how impulsivity directed by delusions and hallucinations resulted in unpredictable actions with only moments from decision to conduct. Suicide was seen as an escape not only from life problems but also from psychotic experiences and intense anxiety. Participants reported being in a chaotic state, unable to think rationally or anticipate the consequences of their actions. Their ability to identify and communicate psychotic symptoms and suicidal ideation and behavior was compromised, leaving them to struggle alone with these terrifying experiences. Conclusions: Suicide risk assessments based on verbal reports from individuals with psychotic depression may not always be valid due to potential impulsivity and underreporting of suicidal ideation. It may be important for clinicians to explore the delusional content of such patients’ experiences to assess the possibility of suicide as a result of shame, guilt, remorse, or altruistic intentions to save others from harm.

Right unilateral electroconvulsive therapy does not cause more cognitive impairment than pharmacologic treatment in treatment-resistant bipolar depression: A 6-month randomized controlled trial follow-up study

Electroconvulsive therapy is an effective treatment for bipolar depression, but there are concerns about whether it causes long‐term neurocognitive impairment.

Remifentanil as an adjunct to anaesthesia for electroconvulsive therapy fails to confer long-term benefits

Background: Adding the &mgr;‐opioid receptor agonist remifentanil to agents used to induce general anaesthesia in electroconvulsive therapy (ECT) can reduce the required doses of induction agents and their unfavourable effects on seizure threshold and quality. However, whether remifentanil has favourable long‐term treatment effects in terms of response and remission rates, speed of response and remission, and side‐effects has not been studied. Methods: This retrospective, register‐based cohort study involved patients with major depression consecutively treated at two units at different hospitals in Norway with the same ECT procedure. Both units used thiopental for ECT anaesthesia, but only one unit added remifentanil (R+; n=47; 541 sessions), whereas the other did not (R–; n=119; 1166 sessions). A Cox proportional hazards model for interval‐censored data was conducted to examine the effects of remifentanil on the time to response and remission from depressive symptoms, whilst adjusting for age, sex, and baseline depression score. Results: Both R+ and R– patients showed substantial reductions of depressive symptoms, with no difference in the response (76% in both groups) or remission (63% vs 65%) rate. However, R+ patients responded (hazard ratio=0.59; 95% confidence interval: 0.4–0.8) and remitted (hazard ratio=0.72; 95% confidence interval: 0.5–1.0) more slowly, and reported more often side‐effects of nausea (30% vs 8%; P<0.001), dizziness (22% vs 8%; P=0.027), and headache (48% vs 23%; P=0.004). Conclusions: The use of adjunctive remifentanil was associated with more short‐term side‐effects and no favourable long‐term clinical outcomes. The practice of routinely adding remifentanil to barbiturate anaesthesia should therefore be reconsidered.

1600 – Establishment of a regional register for neurstimulation treatment in the western part of norway

Introduction Electroconvulsive therapy (ECT) is a highly effective treatment option mainly in severe depression. ECTs longterm effects on cognitive function are currently unknown, limiting its use. Transcranial magnet stimulation (TMS), is considered less effective than ECT in treatment of severe depression, but is without cognitive side effects. TMS is studied to a less degree than ECT. Objectives There is a need of large scale studies of effect, side effects and patients’ subjective experience of ECT and TMS. Aims Generate data to better predict which patients will benefit from ECT and TMS by establishing a regional register including all patients referred to ECT and TMS as part of an ordinary clinical treatment practice in the western part of Norway. Methods All patients referred to ECT and TMS in Bergen and Stavanger will be asked to participate in the study. There are no exclusion criteria. Demographics and course of illness factors will be recorded before start of ECT. Severity of the depressive disorder and treatment effects will be evaluated with a mix of self evaluation and clinician administrated standardized rating instruments. There will be a follow up at 6 months. Date from the described register will be merged with other relevant central Norwegian health registers. Results We expect the described regional register to offer an opportunity to determine predictors for effect, side effects and subjective satisfaction of the treatments. Conclusion This register is investigator initiated, with the aim to investigate which patient will benefit from ECT and TMS without serious side effects.